There are substantial racial disparities in rectal cancer. Between 1973 and 1995 the incidence of rectal cancer decreased 20.2% in whites but only 2.0% in blacks. The five year relative survival is currently 63.0% in whites but only 52.5% in blacks. Surprisingly, there have been few studies that have investigated the racial differences in rectal cancer. The primary goal of the proposed research is to examine possible exposure, susceptibility, and health care factors that might explain diverging incidence and mortality trends in blacks and whites. The proposed proj4ect is a population-based case-control study in a 33-county area of North Carolina with the following aims: (1) To evaluate factors that might account for the higher rectal cancer mortality among blacks including income/poverty, insurance, transportation, access to care, attitudes about the medical care system and diagnostic delay. (2) To identify environmental and lifestyle may be related to rectal cancer including: personal characteristics, family history, physical activity, aspirin/non-steroidal use, and dietary supplements, with special emphasis on exposures that are amenable to intervention (e.g. moderate physical activity, diet, vitamin supplements). Cases will be identified using the rapid ascertainment program of the North Carolina Central Cancer Registry. Controls under age 65 will be drawn from data tapes from the North Carolina Department of Motor Vehicles and those 65 and older from HCFA. Cases and controls will be interviewed by telephone about a range of dietary and lifestyle factors. A major strength of the proposed study is the fact that it builds upon the infrastructure created for an ongoing population-based study of colon cancer. The proposed study of rectal cancer will extend this research to provide insight into risk factors and health access in a mixed-mice, mixed urban-rural-suburban population.